Advertisement

Basics

  • Bertrand Richert
  • Nilton Di Chiacchio
  • Marie Caucanas
  • Nilton Gioia Di Chiacchio
Chapter
  • 518 Downloads

Abstract

Performing successful nail surgery requires a comprehensive knowledge of nail anatomy and physiology. Understanding both the vascular and neural pathways supplying the nail complex, the functions and relationship of each component of the nail unit is also essential. The preoperative consultation is mandatory as it allows a detailed evaluation of the patient as well as a full information about the procedure and post operative evolution. The nail surgeon should use adequate instruments for nail surgery and be aware of the techniques and tips allowing an efficient anesthesia with minimal patient discomfort. Post operative procedure includes the proper use of painkillers and wound care. As for any kind of surgery, the operator needs to prevent and handle any complication that may occur during follow-up.

Keywords

Nail Anatomy Nail instruments Nail unit anesthesia Dressings 

References

  1. 1.
    Haneke E, Lawry M. Nail surgery. In: Robinson JK, Hanke CW, Siegel DM, Fratila A, editors. Surgery of the skin: procedural dermatology. 3rd ed. London: Elsevier Saunders; 2015. p. 755–80.Google Scholar
  2. 2.
    Haneke E. Surgical anatomy of the nail apparatus. Dermatol Clin. 2006;24:291–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Richert B, Caucanas M, André J. Diagnosis using nail matrix. Dermatol Clin. 2015;33(2):243–55.CrossRefPubMedGoogle Scholar
  4. 4.
    Haneke E. Nail Surgery. Surgical anatomy of the nail apparatus. In: Richert B, Di Chiacchio N, Haneke E, editors. Nail Surgery. 1st ed. London: Healthcare; 2010. p. 1–10.Google Scholar
  5. 5.
    de Berker D. Nail anatomy. Clin Dermatol. 2013;31:509–15.CrossRefPubMedGoogle Scholar
  6. 6.
    Dawber RP, de Berker DAR, Baran R. Science of the nail apparatus. In: Diseases of the nails and their management. 2nd ed. Oxford: Blackwell Science; 1994. p. 1–34.Google Scholar
  7. 7.
    Johnson M, Comaish JS, Shuster S. Nail is produced by the normal nail bed: a controversy resolved. Br J Dermatol. 1991;125:27–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Johnson M, Shuster S. Continuous formation nail along the bed. Br J Dermatol. 1993;128:277–80.CrossRefPubMedGoogle Scholar
  9. 9.
    Heidelbaugh JJ, Lee H. Management of the ingrown toe nail. Am Fam Physician. 2009;79(4):303–8.PubMedGoogle Scholar
  10. 10.
    Tosti A, Cameli N, Piraccini BM, et al. Characterization of nail matrix melanocytes with anti-PEP1, anti-PEP8, TMH-1, and HMB-45 antibodies. J Am Acad Dermatol. 1994;31:193–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Perrin C, Michiels JF, Pisani A, et al. Anatomic distribution of melanocytes in normal nail unit: an immunohistochemical investigation. Am J Dermatopathol. 1997;19:462–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Baran R, Juhlin L. Bone dependent nail formation. Br J Dermatol. 1986;114:371–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Kelikian H. Congenital deformities of the hand and forearm. Philadelphia: WB Saunders; 1974.Google Scholar
  14. 14.
    Guéro S, Guichard S, Fraitag SR. Ligamentary structure of the base of the nail. Surg Radiol Anat. 1994;16:47–52.CrossRefPubMedGoogle Scholar
  15. 15.
    Baran R, Grognard C, Duhard E, et al. Congenital malalignment of the great toenail. A enigma solved by a new surgical treatment. Ann Dermatol Vénéréol. 1998;125 suppl 1:S56.Google Scholar
  16. 16.
    Otley CC. Perioperative evaluation and management in dermatologic surgery. J Am Acad Dermatol. 2006;54:119–27.CrossRefPubMedGoogle Scholar
  17. 17.
    Richert B. Basic nail surgery. Dermatol Clin. 2006;24:313–22.CrossRefPubMedGoogle Scholar
  18. 18.
    Abimelec P, Dumontier C. Basic and advanced nail surgery. In: Scher RK, Daniel CR, editors. Nails: diagnosis, therapy, surgery. 3rd ed. Philadelphia: Elsevier Saunders; 2005. p. 265–89.CrossRefGoogle Scholar
  19. 19.
    Córdoba-Fernández A, Ruiz-Garrido G, Canca-Cabrera A. Algorithm for the management of antibiotic prophylaxis in onychocryptosis surgery. Foot. 2010;20(4):140–5.CrossRefGoogle Scholar
  20. 20.
    Wright TI, Baddour LM, Berbari EF. Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008. J Am Acad Dermatol. 2008;59:464–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Zook EG. Preoperative and postoperative management. In: Krull EA, Zook EG, Baran R, Haneke E, editors. Nail surgery: a text and atlas. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 29–35.Google Scholar
  22. 22.
    Alcalay J, Alkalay R. Controversies in perioperative management of blood thinners in dermatologic surgery: continue or discontinue? Dermatol Surg. 2004;30:1091–4.PubMedGoogle Scholar
  23. 23.
    Kovich O, Otley CC. Thrombotic complications related to discontinuation of warfarin and aspirin therapy perioperatively for cutaneous operation. J Am Acad Dermatol. 2003;48:233–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Abimelec P. Tips and tricks in nail surgery. Semin Cutan Med Surg. 2009;28:55–60.CrossRefPubMedGoogle Scholar
  25. 25.
    Hixson FP, Shafiroff BB, Werner FW, et al. Digital tourniquets: a pressure study with clinical relevance. J Hand Surg [Am]. 1986;11:865–8.CrossRefGoogle Scholar
  26. 26.
    Mallard F, Saint-Cast Y, Richou J, Le Nen D. Long-term functional outcomes of digital ischemia under tourniquet: observations in three cases. Chir Main. 2012;31(6):358–63.CrossRefPubMedGoogle Scholar
  27. 27.
    Harrington AC, Cheyney JM, Kinslay-Scott T, et al. A novel tourniquet technique using a sterile glove and hemostat. Dermatol Surg. 2004;30:1065–7.PubMedGoogle Scholar
  28. 28.
    Yuk Ming Tang W. A latex finger strip and nylon zip-tie combo as a tunable digital tourniquet. Dermatol Surg. 2007;33:713–5.Google Scholar
  29. 29.
    Bhatia AC, Taneja A. Surgical instruments. In: Vidimos AT, Ammirati CT, Poblete-Lopez CH, editors. Dermatologic surgery. Philadelphia: Saunders Elsevier; 2009. p. 59–71.Google Scholar
  30. 30.
    Klebish DJ, Zurakowski D, Wilson MG, Chiodo CP. Preoperative skin preparation of the foot and ankle: bristles and alcohol are better. J Bone Joint Surg. 2005;87:986–92.CrossRefGoogle Scholar
  31. 31.
    Bibbo C, Patel DV, Gehrmann RM, Lin SS. Chlorhexidine provides superior skin decontamination in foot and ankle surgery. Clin Orthop Relat Res. 2005;438:204–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Ng AB, Adeyemo FO, Samarji R. Preoperative footbaths reduce bacterial colonization of the foot. Foot Ankle Int. 2009;30:860–4.CrossRefPubMedGoogle Scholar
  33. 33.
    Tanner J, Khan D, Walsh S, et al. Brushes and picks used on nails during the surgical scrub to reduce bacteria: a randomized trial. J Hosp Infect. 2009;71:234–8.CrossRefPubMedGoogle Scholar
  34. 34.
    Becerro de Bengoa Vallejo R, Losa Iglesias ME, Alou Cervera L, et al. Preoperative skin and nail preparation of the foot: comparison of the efficacy of 4 different methods in reducing bacterial load. J Am Acad Dermatol. 2009;61:986–92.CrossRefPubMedGoogle Scholar
  35. 35.
    Morgan AM, Baran R, Haneke E. Anatomy of the nail unit in relation to the distal digit. In: Eds Krull EA, Zook EG, Baran R, Haneke E, editors. Nail surgery: a text and atlas. Philadelphia: Lippincott Williams & Williams; 2001. p. 1–28.Google Scholar
  36. 36.
    Zook EG, Baran R, Haneke E, Dawber RPR. Nail surgery and traumatic abnormalities, chap 10. In: Baran R, Dawber RPR, de Berker DAR, Haneke E, Tosti A, editors. Nail diseases and their management. Oxford: Blackwell Scientific Publications; 2001. p. 425–514.CrossRefGoogle Scholar
  37. 37.
    Sylaidis P, Logan A. Digital blocks with adrenaline. An old dogma refuted. J Hand Surg. 1998;23:17–9.CrossRefGoogle Scholar
  38. 38.
    Thomson CJ, Lalonde DH, Denkler KA, et al. A critical look at the evidence for and against epinephrine use in the finger. Plast Reconstr Surg. 2007;119:114–266.Google Scholar
  39. 39.
    Sylaidis P, Logan A. Epinephrine in digital blocks: revisited. Ann Plast Surg. 1999;43:572.CrossRefPubMedGoogle Scholar
  40. 40.
    Whilelmi BJ, Blackwell SJ, Miller JH, Mancoll JS, Dardano T, Tran A, Phillips LG. Do not use epinephrine in digital blocks: myth or truth? Plast Reconstr Surg. 2001;107:393–7.CrossRefGoogle Scholar
  41. 41.
    Andrades PR, Olguin FA, Calderon W. Digital blocks with or without epinephrine. Plast Reconstr Surg. 2003;111:1769–70.CrossRefPubMedGoogle Scholar
  42. 42.
    Lalonde DH, Lalonde JF. Discussion. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126(6):2035–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Prabhakar H, Rath S, Kalaivani M, Bhanderi N. Adrenaline with lidocaine for digital nerve blocks. Cochrane Database Syst Rev. 2015;3:CD010645.PubMedGoogle Scholar
  44. 44.
    Córdoba-Fernández A, Rodríguez-Delgado FJ. Anaesthetic digital block with epinephrine vs. tourniquet in ingrown toenail surgery: a clinical trial on efficacy. J Eur Acad Dermatol Venereol. 2015;29(5):985–90.Google Scholar
  45. 45.
    Reichl M, Quinton D. Comparison of 1% lignocaine with 0.5% bupivacaine in digital ring blocks. J Hand Surg. 1987;12:375–6.CrossRefGoogle Scholar
  46. 46.
    Peng PW, Coleman MM, McCartney CJ, Krone S, Chan V, et al. Comparison of anaesthetic effect between 0.375% rovipacaine versus 0.5% lidocaine in forearm intravenous regional anaesthesia. Reg Anesth Pain Med. 2002;27:595–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Moffit DL, de Berker DAR, Kennedy CTK, Shutt LE. Assessment of ropivacaine as a local anaesthetic for skin infiltration in skin surgery. Dermatol Surg. 2001;27:437–40.Google Scholar
  48. 48.
    Fayman M, Beeton A, Potgieter E, Becker PJ. Comparative analysis of bupivacaine and rovipacaine for infiltration analgesia for bilateral breast surgery. Aesthetic Plast Surg. 2003;27:100–3.CrossRefPubMedGoogle Scholar
  49. 49.
    Gherardini G, Samuelson U, Jernbeck J, et al. Comparison of vascular effect of rovipacaine and lidocaine on isolated rings of human arteries. Acta Anaesthesiol Scand. 1995;39:765–8.CrossRefPubMedGoogle Scholar
  50. 50.
    Hamelin ND, St-Amand H, Lalonde DH, Harris PG, Brutus JP. Decreasing the pain of finger block injection: level II evidence. Hand (NY). 2013;8(1):67–70.CrossRefGoogle Scholar
  51. 51.
    Dialynas M, Hollingsworth S, Cooper D, Barker S. Use of a needleless injection system for digital ring block anesthesia. J Am Pod Med Assoc. 2003;93:23–6.CrossRefGoogle Scholar
  52. 52.
    Salashe S. Surgery, chap 19. In: Scher RK, Daniel CD, editors. Nails: therapy, diagnosis and surgery. Philadelphia: Saunders; 1990. p. 258–80.Google Scholar
  53. 53.
    Jellinek NJ. Nail surgery: practical tips and treatment options. Dermatol Ther. 2007;20:68–74.CrossRefPubMedGoogle Scholar
  54. 54.
    Browne J, Fung M, Donnely M, Cooney C. The use of EMLA reduces the pain associated with digital ring block for ingrowing toenail correction. Eur J Anaesthesiol. 2000;17:182–4.CrossRefPubMedGoogle Scholar
  55. 55.
    Serour F, Ben-Yehuda Y, Boaz M. EMLA cream prior to digital nerve block for ingrown toenail surgery does not reduce pain at injection of anesthetic solution. Acta Anaesthesiol Scand. 2002;46:203–6.CrossRefPubMedGoogle Scholar
  56. 56.
    Smith KC, Comite SL, Bralasubramanian S, et al. Vibration anesthesia: a non-invasive method of reducing discomfort prior to dermatologic procedures. Dermatology Online J. 2004;10(2):1.Google Scholar
  57. 57.
    Cornelius P, Kendall J, Meek S, Rajan R. Alkalinisation of lignocaine to reduce the pain of digital nerve blockade. J Accid Emerg Med. 1996;13:339–40.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Aycock BG, Hawtof DB, Moody SB. Treatment of peripheral ischemia secondary to lidocaine containing epinephrine. Ann Plast Surg. 1989;23:27–30.CrossRefPubMedGoogle Scholar
  59. 59.
    Fays-Michel S, Vieu C, Tréchot P, et al. Cutaneous necrosis following ambulatory phlebectomy: the role of sodium bicarbonate used in local anesthesia. Ann Dermatol Venereol. 2007;134:76–7.CrossRefPubMedGoogle Scholar
  60. 60.
    Flarity-Reed K. Methods of digital block. J Emerg Nurs. 2002;28:351–4.CrossRefPubMedGoogle Scholar
  61. 61.
  62. 62.
    Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for nail disorders. J Am Acad Dermatol. 1996;34:529–33.CrossRefGoogle Scholar
  63. 63.
    Walsh ML, Shipley DV, de Berker DAR. Survey of patient’s experiences after nail surgery. Clin Exp Dermatol. 2009;34:154–6.CrossRefGoogle Scholar
  64. 64.
    Richert B, Dahdah M. Complications in nail surgery. In: Nouri K, editor. Complications in dermatologic surgery. Philadelphia: Mosby Elsevier; 2008. p. 137–58.CrossRefGoogle Scholar
  65. 65.
    Walsh ML, Shipley DV, de Berker DA. Survey of patients’ experiences after nail surgery. Clin Exp Dermatol. 2009;34(5):e154–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Bertrand Richert
    • 1
  • Nilton Di Chiacchio
    • 2
  • Marie Caucanas
    • 3
  • Nilton Gioia Di Chiacchio
    • 4
  1. 1.CHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
  2. 2.Dermatology ClinicHospital do Servidor Público MunicipalSão PauloBrazil
  3. 3.Clinique St Jean LanguedocToulouseFrance
  4. 4.Hospital do Servidor Público MunicipalSão PauloBrazil

Personalised recommendations